Characterization of risk factors for sudden infant deaths


Dr Swati Y Bhave, Adjunct Professor in Adolescent Medicine; Dr D Y Patil Medical College, & Dr D Y Patil Vidyapeeth, Pune; Sr. consultant, Adolescent Pediatrics & Head-In-charge of Adolescent Wellness Clinic, Jehangir Hospital Pune    20 December 2022

Infants who sleep on a non-approved sleep surface and use soft bedding are at a considerably high risk of explained suffocation, according to a study published online Dec. 5, 2022 in the journal Pediatrics.1


This study sought to explore the risk factors for sleep-related suffocations and unexplained infant deaths (including deaths due to sudden infant death syndrome [SIDS]) together grouped as sudden infant deaths. For this the researchers analysed data from the Sudden Unexpected Infant Death (SUID) Case Registry of the Centers for Disease Control and Prevention data, from 2016 to 2017. Liveborn infants from the Pregnancy Risk Assessment Monitoring System (PAM) constituted the control group. The age group of the infants included in the study was 2 to 9 months; 300 unexplained infant death cases with 1,200 age-matched controls and 112 sleep-related suffocation cases with 448 age-matched controls.


Among infants who did not share a room with their mother or caregiver, the risk of sleep-related suffocation was increased by almost 19-folds with adjusted odds ratio of 18.7. They were also nearly 8 times more at risk of unexplained death with aOR of 7.6 compared with infants who shared a room. Infants who shared their sleep area with their pet/toys or another person also doubled their risk of sleep-related suffocation or unexplained infant death with aORs of 2.5 and 2.1, respectively.


Infants who slept in a nonsupine (not on back) sleep position were nearly 2 times more likely to experience sleep-related suffocation and unexplained death with aORs of 1.9 and 1.6 respectively.


The risk of explained suffocation increased 16 times among infants who slept on a soft bedding such as loose bedding, stuffed toys and other objects close by (aOR 16.3) than in those who did not sleep on soft bedding. The risk of unexplained death was also increased among these infants (aOR 5.0). Infants who did not sleep in a crib, bassinet, or portable crib were 4 times more at risk of explained suffocation death vs infants who slept on a firm and non- inclined sleep surface (aOR 3.9). No such association was  observed for unexplained sleep death in this group of infants (aOR 1.0).


This study has reiterated the association of unsafe infant sleep practices and sleep-related suffocation and unexplained infant death. It has also characterized the risk factors separately for sleep-related suffocation and unexplained infant death. Infants who slept alone were at the highest risk, almost 20 times higher, of sleep-related suffocation and unexplained infant death. Non approved sleep surface was strongly associated with explained suffocation, but not with unexplained sleep death. Use of soft bedding had a stronger association with suffocation than unexplained death.


In its updated 2022 recommendations for reducing infant deaths in the sleep environment, the  American Academy of Pediatrics (AAP) recommends use of a firm, noninclined sleep surface, supine positioning, avoidance of soft bedding, room sharing without bed sharing and overheating.2


By highlighting the associated dangers, the findings of this study can be used by pediatricians to educate parents about safe sleep.



  1. Parks SE, et al. Risk Factors for Suffocation and Unexplained Causes of Infant Deaths. Pediatrics. 2022 Dec 5:e2022057771. doi: 10.1542/peds.2022-057771.
  2. Moon RY, et al. Sleep-Related infant deaths: updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics. 2022 Jul 1;150(1):e2022057990. doi: 10.1542/peds.2022-057990.

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